It has become clear that, as Janet observed one hundred years ago, dissociation lies at the heart of the traumatic stress disorders. Studies of survivors of disasters, terrorist attacks, and combat have demonstrated that people who enter a dissociative state at the time of the traumatic event are among most likely to develop long-lasting PTSD.

First, the physiological symptoms of post-traumatic stress disorder have been brought within manageable limits. Second, the person is able to bear the feelings associated with traumatic memories. Third, the person has authority over her memories; she can elect both to remember the trauma and to put memory aside. Fourth, the memory of the traumatic event is a coherent narrative, linked with feeling. Fifth, the person's damaged self-esteem has been restored. Sixth, the person's important relationships have been reestablished. Seventh and finally, the person has reconstructed a coherent system of meaning and belief that encompasses the story of trauma.

The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.

Dissociation is the common response of children to repetitive, overwhelming trauma and holds the untenable knowledge out of awareness. The losses and the emotions engendered by the assaults on soul and body cannot, however be held indefinitely. In the absence of effective restorative experiences, the reactions to trauma will find expression. As the child gets older, he will turn the rage in upon himself or act it out on others, else it all will turn into madness.

I went to a psychiatrist (NBC insisted we all go) and told her I had been through traumatic experiences before and understood that the kidnapping would leave “fingerprints” on me for a while. The key was knowing what to expect. If you get blind drunk, you know you’re going to wake up with a hangover. By the same token, I expected post-traumatic stress symptoms—anger, irritability, a sense of isolation—and I experienced those feelings, off and on, for several months. It’s like having the monkey on your back again, and being self-aware helps shake him off.

It is as though some old part of yourself wakes up in you, terrified, useless in the life you have, its skills and habits destructive but intact, and what is left of the present you, the person you have become, wilts and shrivels in sadness or despair: the person you have become is only a thin shell over this other, more electric and endangered self. The strongest, the least digested parts of your experience can rise up and put you back where you were when they occurred; all the rest of you stands back and weeps.